体外膈肌起搏联合tDCS对脑卒中后吞咽障碍患者康复分析

Analysis of rehabilitation effect of external diaphragmatic pacing combined with transcranial direct current stimulation on patients with swallowing disorder after stroke

目的探讨体外膈肌起搏联合经颅直流电刺激(tDCS)对脑卒中后吞咽障碍患者康复效果。方法选择2017年2月至2019年6月在徐州医科大学附属淮安医院接受治疗的脑卒中后吞咽障碍患者94例,随机分为2组各47例。两组患者均行常规治疗及吞咽功能训练,对照组在此基础上加以tDCS治疗,观察组在对照组基础上加以体外膈肌起搏治疗。对比两组患者临床疗效、经口进食情况、呼吸功能、舌骨前移及上移速度、表面肌电图检查结果。结果观察组总有效率为95.74%,显著高于对照组的82.98%(P<0.05)。治疗后两组患者功能性经口摄食量表(FOIS)评分、用力肺活量(FVC)、每分钟最大通气量(MVV)水平、舌骨前移、舌骨上移速度及最大波幅均明显升高,但观察组升高幅度更大(P<0.05),治疗后两组患者呼吸频率(BF)、吞咽时程均明显下降,但观察组下降幅度更大(P<0.05)。结论体外膈肌起搏联合tDCS较单独采用t DCS可显著提高脑卒中后吞咽障碍患者临床疗效,改善患者经口进食情况及呼吸功能,提升舌骨前移及上移速度,改善表面肌电图相关指标。

Objective To investigate the rehabilitation effect of external diaphragmatic pacing combined with transcranial direct current stimulation(tDCS)on patients with swallowing disorder after stroke.Methods A total of 94 patients with swallowing disorder after stroke who were treated in Huaian Hospital Affiliated to Xuzhou Medical University from February 2017 to June 2019 were selected for study.The patients were divided into 2 groups by random number table method,with 47 cases in each group.Both groups of patients were given conventional treatment and swallowing function training.The control group was treated with tDCS based on this.The observation group was treated with external diaphragm pacing based on the control group.The clinical efficacy,oral eating conditions,respiratory function,hyoid forward and upward velocity,and surface electromyographic findings were compared between the two groups of patients.Results The total effective rate in the observation group was 95.74%,which was significantly higher than 82.98%in the control group(P<0.05).After treatment,the FOIS scores of the two groups were significantly increased,but the increase was greater in the observation group(P<0.05).After treatment,the levels of FVC and MVV in the two groups were significantly increased,but the increase was greater in the observation group.After treatment,the BF in both groups was significantly reduced,but the observation group was significantly lower(P<0.05).The speed of hyoid advancement and hyoid advancement increased significantly in both groups after treatment,but the increase was greater in the observation group(P<0.05).After treatment,the maximum amplitude of the two groups of patients increased significantly,but the observation group increased more significantly.After treatment,the swallowing duration of both groups of patients significantly decreased,but the observation group decreased significantly(P<0.05).Conclusion Compared with tDCS alone,extracorporeal diaphragm pacing combined with tDCS can significantly improve the clinical effect of patients with swallowing disorder after stroke,improve their oral feeding and respiratory function,increase the speed of hyoid forward and upward movement,and improve the related indexes of SEMG.